Total quality management for healthcare

ABSTRACT

A model and method for total quality management in healthcare data management includes receiving healthcare related goals determined by a patient. A healthcare record associated with the patient is maintained and stored in a database. The healthcare record pertains to the healthcare related goal(s) from at least one healthcare service provider. Performance of activities of the healthcare service provider(s) is evaluated with respect to achieving the healthcare related goal(s). Feedback is provided to the patient regarding the performance evaluation of the healthcare service provider(s).

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims priority to U.S. Provisional PatentApplication No. 61/749,341, filed Jan. 6, 2013 entitled TOTAL QUALITYMANAGEMENT FOR HEALTHCARE, which is incorporated herein by reference inits entirety.

TECHNICAL FIELD

The present disclosure relates to healthcare management services andmore particularly to total quality management for healthcare services.

BACKGROUND

Currently, the organization of healthcare services is generally based onparticular healthcare delivery systems, rather than the patient. Forexample, doctors are paid based on services that they document during anencounter with a patient, rather than outcomes of their care.

Healthcare information, which is vital to providing healthcare services,has heretofore been very poorly managed. For example, doctors and otherhealth care providers generally are not assured of having access to allof a patient's information at the time of an encounter with the patient.Patients who wish to provide their healthcare information to be providedto all of their providers generally must themselves take affirmativesteps to ensure that the information is available to the providers.

Doctors who are expected to provide patients with a copy of theirencounter notes often do not do so. Therefore, it has been difficult forpatients to assure that their healthcare information or their care iscoordinated among various providers. Moreover, providers and patientsare often burdened by entering the same data on multiple forms andentering redundant data into multiple systems.

SUMMARY

Aspects of the present disclosure include a model of care for valuebased care management that embeds total quality management into care.According to aspects of the present disclosure, the model includes anefficient method for providers to document their care by interactingwith the consumer's “Quality Health Record.” The model also incorporatestelemedicine services to improve access while saving money. According toaspects of the present disclosure, the model also includes a method tocollect core outcomes data on all patient encounters as part of the caredelivery process by using core communication standards. Aspects of thepresent disclosure also include methods to drive adoption by bothproviders and consumers.

BRIEF DESCRIPTION OF THE DRAWINGS

The features, nature, and advantages of the present disclosure willbecome more apparent from the detailed description set forth below whentaken in conjunction with the drawings in which like referencecharacters identify correspondingly throughout.

FIGS. 1-13 are process flow diagrams showing workflow practice andstandards of practice for information management for defined types ofhealthcare service encounter according to aspects of the presentdisclosure.

FIGS. 14A-14C show a data structure diagram illustrating an example of aQuality Health Record according to aspects of the present disclosure.

FIG. 15 is conceptual diagram illustrating, a provider care cardaccording to aspects of the present disclosure.

FIG. 16 is process flow diagram showing an example of method of totalquality management of healthcare activities according to aspects of thepresent disclosure.

FIG. 17 is conceptual diagram illustrating, a total quality managementsystem for managing healthcare activities according to aspects of thepresent disclosure.

DETAILED DESCRIPTION

Embodiments of the present disclosure will be described herein withreference to the accompanying drawings. However, this disclosure shouldnot be construed as limited to the embodiments set forth herein. Rather,these embodiments are provided so that this disclosure will be thoroughand complete, and will fully convey the scope of the disclosure to thoseskilled in the art. Like numbers refer to like elements throughout. Asused herein the term “and/or” includes any and all combinations of oneor more of the associated listed items and may be abbreviated as “/”.

The integration of quality of care and cost of care to provide valuebased care contracting for healthcare services is an emerging concept inthe healthcare industry. It is generally believed that the provision ofhealthcare services should be based on payment for outcomes of care,rather than payment based merely on service of care. Value can generallybe defined as a quality measure divided by a cost. Historically it hasbeen difficult or practically impossible to implement value based healthcare services due to a number of key challenges.

A first key challenge results from the lack of verifiable standards ofpractice in health care. Another key challenge result from the lack ofquality measurements for patient encounters. Quality not routinelymeasured on all patient encounters. A key step to assure quality is toassure that patients understand and follow certain expected patienttasks. This allows the patients to be accountable for their owncontribution to quality outcomes of care. Given that quality data is notroutinely collected and data on patient adherence is not routinelymeasured, it has been a challenge to implements effective doctor qualityimprovement programs.

At least from the patients' perspective, one component of value inhealthcare services is the ability to access doctors and other healthcare providers remotely, via telephone, email, and/or other means oftelemedicine, for example. Another component of value in healthcareservices is the level to which providers apply the most up to dateknowledge and practices for their particular practice area. Currenthealthcare systems generally lack assurances that doctors and otherproviders are up-to-date on their treatment practices.

At least from the healthcare providers' perspective, a key component ofvalue in healthcare is an assurance of timely and adequate payment forservices. Currently cost data for healthcare services is not generallyaccessible in real time. Thus financial management has been verydifficult for doctors and other healthcare providers who do not knowwhen they will be paid or what amount of compensation they should expectfor their services.

Aspects of the present disclosure provide a framework for implementingvalue based care services based on total quality management techniques.A total quality management model according to aspects of the presentdisclosure starts with the establishment of standards of practice forinformation management, communication standards, and outcomes collectionfor ambulatory and institution based care. According to an aspect of thepresent disclosure, the model is patient-centered, allows the patient toaccess telemedicine and continuously reconciles the patient's care planto include providers' treatment recommendations. The model includesalgorithms to collect outcomes and patient adherence on healthcareencounters.

According to aspects of the present disclosure, adoption of the model isdriven by payment of providers at the point of service completion ifstandards are met. The model also provides feedback and a practice basedimprovement program to assist providers to continuously improve qualityand decrease total cost of care. The practice based improvement programmay include adjustment of population health for patient social/clinicalrisk factors and adherence, service and education improvement, andupdates to the provider knowledge base to assure that practitioner isup-to-date, for example.

According to aspects of the present disclosure, the system of careincludes a data model and information system referred to herein as a“Quality Health Record.” The Quality Health Record provides core patientdata to “smart forms” or electronic record systems. This reduces oreliminates inefficiencies that result from duplicate data entry andimplements continuous collection of actionable quality data as part ofthe care delivery process.

According to aspects of the present disclosure, data from the QualityHealth Record is used to provide peer comparison reports and a processfor providers to improve quality (population health, service, andknowledge) and decrease cost.

Standards of Practice

Aspects of the present disclosure define standards of practice for caredelivery, communication, and information management to collect outcomesof care on patient encounters in a patient centered care system.According to aspects of the present disclosure a number of encountertypes that a consumer can have with their healthcare delivery system areidentified. The encounter types include both ambulatory encounters andinstitutional encounters, for example. For each of the identifiedencounter types, aspects of the present disclosure include a bestworkflow practice and standards of practice for information management.The best workflow practice and standards of practice for informationmanagement assure that the care plan is reconciled, careresponsibilities are defined for all members of the consumer's careteam, tasks are assigned (including the patient's) and outcomes aredefined and collected.

Examples of encounter types and corresponding best practices identifiedaccording to aspects of the present disclosure are shown in process flowdiagrams in FIGS. 1-13. FIG. 1 shows a process flow diagram 100illustrating a best workflow practice and standards of practice forinformation management for an initial patient encounter according to anaspect of the present disclosure. FIG. 2 shows a process flow diagram200 illustrating a best workflow practice and standards of practice forinformation management for a nursing home encounter according to anaspect of the present disclosure. FIG. 3 shows a process flow diagram300 illustrating a best workflow practice and standards of practice forinformation management for an in-person external referral to aspecialist or lab according to an aspect of the present disclosure. FIG.4 shows a process flow diagram 400 illustrating a best workflow practiceand standards of practice for information management for a securemessage encounter according to an aspect of the present disclosure.

FIG. 5 shows a process flow diagram 500 illustrating a best workflowpractice and standards of practice for information management for a liveinteractive scheduled telespecialist encounter according to an aspect ofthe present disclosure. FIG. 6 shows a process flow diagram 600illustrating a best workflow practice and standards of practice forinformation management for an autopsy encounter according to an aspectof the present disclosure. FIG. 7 shows a process flow diagram 700illustrating a best workflow practice and standards of practice forinformation management for a biomonitoring encounter according to anaspect of the present disclosure. FIG. 8 shows a process flow diagram800 illustrating a best workflow practice and standards of practice forinformation management for a curbside consultation according to anaspect of the present disclosure.

FIG. 9 shows a process flow diagram 900 illustrating a best workflowpractice and standards of practice for information management for adurable medical equipment (DME) or/medication order encounter accordingto an aspect of the present disclosure. FIG. 10 shows a process flowdiagram 1000 illustrating a best workflow practice and standards ofpractice for information management for in-person episodic and annualvisits for established patients according to an aspect of the presentdisclosure. FIG. 11 shows a process flow diagram 1100 illustrating abest workflow practice and standards of practice for informationmanagement for an emergency encounter according to an aspect of thepresent disclosure. FIG. 12 shows a process flow diagram 1200illustrating a best workflow practice and standards of practice forinformation management for an in-home or in-office encounter accordingto an aspect of the present disclosure. FIG. 13 shows a process flowdiagram 1300 illustrating a best workflow practice and standards ofpractice for information management for hospitalization or surgerycenter encounter for established patients according to an aspect of thepresent disclosure.

According to aspects of the present disclosure, the model includes typesof encounters that are telemedicine based for both the ambulatory andinstitution based encounters. Types of encounters defined according toaspects of the present disclosure may also include care planreconciliation, messaging, telephonic to a practitioner, liveinteractive video to a practitioner, biomonitoring of conditions,curbside consult between practitioners, for example.

Quality Health Record

A Quality Health Record 1400, which facilitates automation of theworkflows and tasks according to aspects of the present disclosure, isshown in FIGS. 14A-14C. The core data that is collected in the QualityHealth Record is part of the patient's ongoing personal health recordmanagement system. According to an aspect of the present disclosure, theQuality Health Record 1400 includes a record of users 1402, a record ofambulatory service providers 1404, a record of institution basedproviders 1406, a record of user information 1408, a record ofagreements 1410, a record of encounter data 1412, a record of consumerinformation 1414, a record of documents, a record of aclinical/financial access card information 1418 and/or a record ofquality management information 1420.

In one implementation, the Quality Health Record uses a markup languagesuch as XML/HL7 for data transfer. According to aspects of the presentdisclosure, data from the Quality Health Record it is used toprepopulate forms and/or electronic systems and is continuously updated.

Consumer-Provider Information Standards

Aspects of the present disclosure include information managementstandards to collect actionable quality data at the point of service.According to an aspect of the present disclosure, quality data iscollected to improve population health and service and patient educationin the ambulatory and institutional setting.

For example, in an ambulatory setting there may be two standards as partof a patient's annual exam. According to an aspect of the presentdisclosure, if patients have a timely annual in-person exam, they arethen eligible to have telemedicine services in the upcoming year withtheir providers. In this example, the first of two informationmanagement standards as part of the annual exam defines an automatedannual age, sex, disease specific HEDIS measures (Health RiskAssessment) to define the “truth” for the patient and goals for wellnessand disease management. The second of two information standards as partof the annual exam defines an annual prevention/preparedness programdiscussion between the patient and their primary care provider to selectone prevention goal for the year, define disease management goals forthe year, and update their medical power of attorney/living will andpersonal preparedness plan for disasters and emergencies.

According to another aspect of the present disclosure two dischargestandards are defined in an institutional setting. The first dischargestandard includes completion of transition checklist that assures thatthe patient's required reporting data is completed. The second dischargestandard includes providing an updated care plan that has beencommunicated to all of the patient's providers for follow up afterdischarge and ensures that consumer understands their plan of care.

According to another aspect of the present disclosure, three practicestandards are defined for all encounters. The first practice standarddefined for all encounters includes providing that a care plan isupdated to assure care coordination and patient knows the plan, goals,and their responsibilities. The second practice standard defined for allencounters includes providing that encounter information is uploadedinto a care plan, by scan, fax, or other electronic transmission, forexample. The third practice standard defined for all encounters includesproviding that follow up of the encounter is established to “close theloop” on care to collect outcomes of care on that encounter.

A provider improvement methodology according to an aspect of the presentdisclosure includes two components. A first component is targeted toimprove future quality and cost, i.e., value. A second component istargeted to improve provider knowledge of disease management andtreatment updates. According to this aspect of the disclosure providersreceive continuing education credit for using a Practice-BasedContinuing Education Program.

A program to improve future quality according to aspects of the presentdisclosure uses data from the Quality Health Record and data from pointof service claims data to provide a number of peer comparison reports toproviders for continuing education credit. According to an aspect of thepresent disclosure the reports include a population health report, anambulatory report including HEDIS measures adjusted for patient socialand clinical factors and patient adherence, an inpatient reportincluding required reporting adjusted for patient social and clinicalfactors, a service/patient engagement report and a cost of care report.

Aspects of the present disclosure include a program to improve providerknowledge annually to assure they are up-to-date. For example, based onthe providers ten most common diseases, they review the best practicefrom a best treatment protocol and document their treatment preferences.According to an aspect of the present disclosure, the best treatmentpractice also defines the core tasks that patients should follow for adisease state and the population health outcomes that should becollected annually as part of the patient's annual age, sex, and diseasespecific health risk assessment.

Aspects of the present disclosure also include a method to driveadoption by providers and consumers. The method includes providingincentives for adopting the model for total quality management ofhealthcare according to aspects of the present disclosure. In oneexample, if providers are active in the Practice based ContinuingEducation Program and follow these standards, they are paid at the pointof service completion. Standards for point of service payment mayinclude requiring that the care plan is updated, requiring thatencounter information is uploaded and requiring that a follow up surveyis sent, for example.

According to an aspect of the present disclosure, certain consumerresponsibilities are defined in their care plan. Incentives are providedfor the consumer to meet their defined responsibilities under the plan.For example, if the consumer follows communication standards for theirannual visit to a provider, they are then eligible to receive servicesin the upcoming year via telemedicine with their provider network.Providers are incentivized by payment for certain telemedicine services.

Provider Care Card

According to another aspect of the present disclosure, a provider carecard is provided to integrate patient clinical and financial data forpoint of service payment if information management standards are met.Referring to FIG. 15, in one example, a front side 1502 of the providercare card identifies a patient and clinical information manager definesthe patient identity access to their secure online record (patient idsuch as personal qr code or biometric (iris scan, fingerprint scanner).In one example, the front side 1502 of the provider care card providesaccess to the patient information for management. A back side of theprovider care card 1504 enables management of financial information andintegrates financial data for healthcare payment (patient and payer—e.g.FSA/Credit card/HSA/payer) with instructions for information managementfor point of service payment.

According to this aspect of the present disclosure, the provider cardprovides a tool for a patient's information to be securely accessed andmanaged, embeds information management standards for the encounterinformation to be collected and reconciled with the patient's overallhealthcare plan, collects information at the point of care, paysproviders if they follow information management standards for point ofservice payment.

The provider care card assures that practitioners have access toaccurate and actionable information for patients being encountered. Italso provides contact information to enable the patient to contact thepatient's designated physician.

For point of service payment, the practitioner seeing the patient at thetime of card use then can be paid more quickly if they followinformation management instructions on the back side 1504 of the cardprovider care card. According to aspects of the present disclosure, theprovider care card enables emergency care personnel to have access tothe patient's core information in a HIPAA compliant fashion by accessingthe patient's care plan via the QR/biometric reader.

According to an aspect of the present disclosure the provider care cardcan be issued and managed by an information and quality managementservice. When a patient enrolls for information and quality managementservice, core information of the patient is collected by the informationand quality management service and the patient's online care plan forclinical information is populated. According to an aspect of the presentdisclosure, the information and quality management service also collectthe patient's personal payment information and payer paymentinformation.

The information and quality management service then issue a providercare card for the patient. The issued provider care card includes hasactionable core clinical and financial data on the card/access viamobile devices/computer scanners to access and manage clinical andfinancial data at the point of service. Patients can use their providercare card for everyday healthcare interaction with their providers forclinical and financial information management. Emergency personnel canaccess the core information for the patient to treat at the point ofemergency. According to an aspect of the present disclosure, providerswho follow information management instructions on the provider carecard, are paid at the point of service completion. According to anotheraspect of the present disclosure, the provider care card can be used forinformation management alone by the patient or the patient's designatedinformation manager. The financial aspect of the card could be a healthcredit card or other financial transaction vehicle, for example.

A method for total quality management in healthcare data managementaccording to an aspect of the present disclosure is described withreference to FIG. 16. The method 1600 includes receiving at least onehealthcare related goal determined by a patient at block 1602 andreceiving a healthcare record associated with the patient at block 1604.According to an aspect of the present disclosure, the healthcare recordpertains to the healthcare related goal(s) from at least one healthcareservice provider. The method also includes storing the healthcare recordin a database at block 1606 and evaluating performance of an outcome foran activity of each of the healthcare service provider(s) at block 1608.According to an aspect of the present disclosure, the outcome isassociated with meeting the healthcare related goal(s). The method alsoincludes providing feedback to the patient regarding the performanceevaluation of the healthcare service provider(s) at block 1610.

A total quality management system for healthcare according to anotheraspect of the present disclosure is described with reference to FIG. 17.The system includes a database 1702 configured to receive at least onehealthcare related goal. The system also includes at least onehealthcare record 1704 associated with a patient and indicating thehealthcare related goal(s). According to an aspect of the presentdisclosure, the healthcare record is based on an outcome of an activityfor each of the healthcare service providers wherein the outcome isassociated with meeting the healthcare related goal(s). At least oneprocessor 1706 coupled to the database 1702 is configured to compare theoutcome with the healthcare related goal(s) and provide feedback basedon the comparison to the patient. The system 1700 also includes areporting device 1708 coupled to the processor(s) 1706 and configured todisplay the feedback.

For a firmware and/or software implementation, the methodologies andmodels described herein according to aspects of the present disclosuremay be implemented with modules (e.g., procedures, functions, and so on)that perform the functions, methods and/or processes described herein. Amachine-readable medium tangibly embodying instructions may be used inimplementing the methodologies described herein. For example, softwarecodes may be stored in a memory and executed by a processor unit. Memorymay be implemented within the processor unit or external to theprocessor unit. As used herein the term “memory” refers to types of longterm, short term, volatile, nonvolatile, or other memory and is not tobe limited to a particular type of memory or number of memories, or typeof media upon which memory is stored.

If implemented in firmware and/or software, the functions may be storedas one or more instructions or code on a computer-readable medium.Examples include computer-readable media encoded with a data structureand computer-readable media encoded with a computer program.Computer-readable media includes physical computer storage media. Astorage medium may be an available medium that can be accessed by acomputer. By way of example, and not limitation, such computer-readablemedia can include RAM, ROM, EEPROM, CD-ROM or other optical diskstorage, magnetic disk storage or other magnetic storage devices, orother medium that can be used to store desired program code in the formof instructions or data structures and that can be accessed by acomputer; disk and disc, as used herein, includes compact disc (CD),laser disc, optical disc, digital versatile disc (DVD), floppy disk andblu-ray disc where disks usually reproduce data magnetically, whilediscs reproduce data optically with lasers. Combinations of the aboveshould also be included within the scope of computer-readable media.

In addition to storage on computer readable medium, instructions and/ordata may be provided as signals on transmission media included in acommunication apparatus. For example, a communication apparatus mayinclude a transceiver having signals indicative of instructions anddata. The instructions and data are configured to cause one or moreprocessors to implement the functions outlined in the claims.

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the disclosure.As used herein, the singular forms “a,” “an” and “the” are intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. It will be further understood that the terms “comprises,”“comprising,” “having,” “having,” “includes,” “including” and/orvariations thereof, when used in this specification, specify thepresence of stated features, steps, operations, elements, and/orcomponents, but do not preclude the presence or addition of one or moreother features, steps, operations, elements, components, and/or groupsthereof.

It should be understood that when an element is referred to as being“connected” or “coupled” to another element (or variations thereof), itcan be directly connected or coupled to the other element or interveningelements may be present. In contrast, when an element is referred to asbeing “directly connected” or “directly coupled” to another element (orvariations thereof), there are no intervening elements present.

It should be understood that, although the terms first, second, etc. maybe used herein to describe various elements and/or components, theseelements and/or components should not be limited by these terms. Theseterms are only used to distinguish one element and/or component fromanother element and/or component. Thus, a first element or componentdiscussed below could be termed a second element or component withoutdeparting from the teachings of the present disclosure.

Unless otherwise defined, all terms (including technical and scientificterms) used herein have the same meaning as commonly understood by oneof ordinary skill in the art to which this disclosure belongs. It willbe further understood that terms, such as those defined in commonly useddictionaries, should be interpreted as having a meaning that isconsistent with their meaning in the context of the relevant art and thepresent disclosure, and will not be interpreted in an idealized oroverly formal sense unless expressly so defined herein.

Although the present disclosure has been described in connection withthe embodiments illustrated in the accompanying drawings, it is notlimited thereto. Persons with skill in the art will recognize thatembodiments of the present disclosure may be applied to other types ofmemory devices. The above-disclosed subject matter is to be consideredillustrative, and not restrictive, and the appended claims are intendedto cover all such modifications, enhancements, and other embodiments,which fall within the true spirit and scope of the present disclosure.Thus, to the maximum extent allowed by law, the scope of the presentdisclosure is to be determined by the broadest permissibleinterpretation of the following claims and their equivalents, and shallnot be restricted or limited by the foregoing detailed description.

What is claimed is:
 1. A method for total quality management inhealthcare data management, the method comprising the steps of:receiving at least one healthcare related goal determined by a patient;receiving a healthcare record associated with the patient and pertainingto the at least one healthcare related goal from at least one healthcareservice provider; storing the healthcare record in a database;evaluating performance of an outcome for an activity of each of the atleast one healthcare service provider, wherein the outcome is associatedwith meeting the at least one healthcare related goal; and providingfeedback to the patient regarding the performance evaluation of the atleast one healthcare service provider.
 2. The method of claim 1, whereinstoring the healthcare record comprises: formatting the healthcarerecord in a patient-oriented format.
 3. The method of claim 1, furthercomprising: receiving a health update from the patient; and storing thehealth update in the database.
 4. The method of claim 3, furthercomprising: providing access to the health update to a third party. 5.The method of claim 4, wherein the third party comprises at least oneof: i) the at least one healthcare service provider, ii) an employer,and iii) a health insurance provider.
 6. The method of claim 3, furthercomprising: vetting the health update to conform to a health carerecords standard.
 7. The method of claim 3, further comprising:integrating the healthcare record with the health update in thedatabase.
 8. The method of claim 1, wherein the at least one healthcareservice provider includes at least one of: i) a doctor, ii) medicalinstitution, and iii) a nurse.
 9. The method of claim 1, wherein the atleast one healthcare service provider comprises a first healthcareservice provider and a second healthcare service provider, and furthercomprises: comparing the performance evaluation of the first healthcareservice provider with the performance evaluation of the second healthcare service provider.
 10. The method of claim 8, providing thecomparison to at least one of: i) the patient, ii) the first healthcareservice provider, iii) the second healthcare service provider, and iv) ahealthcare service payor.
 11. A total quality management system forhealthcare, the system comprising: a database configured to receive atleast one healthcare related goal and at least one healthcare recordassociated with a patient and indicating the at least one healthcarerelated goal, wherein the healthcare record is based on an outcome of anactivity for each of the at least one healthcare service provider, andthe outcome is associated with meeting the at least one healthcarerelated goal; at least one processor coupled to the at least onedatabase and configured to compare the outcome with the at least onehealthcare related goal and provide feedback based on the comparison tothe patient; and a reporting device coupled to the at least oneprocessor configured to display the feedback.
 12. The system of claim11, wherein the at least one processor is further configured to formatthe at least one healthcare record in a patient-oriented format.
 13. Thesystem of claim 11, wherein the at least one processor is furtherconfigured to receive and store a health update from the patient to thedatabase.
 14. The system of claim 13, wherein the at least one processorfurther configured to transmit the feedback to a third party.
 15. Thesystem of claim 14, wherein the third party comprises at least one of:i) the at least one healthcare service provider, ii) an employer, andiii) a health insurance provider.
 16. The system of claim 11, whereinthe at least one healthcare service provider includes at least one of:i) a doctor, ii) a medical institution, and iii) a nurse.
 17. The systemof claim 11, wherein the at least one healthcare service providercomprises a first healthcare service provider and a second healthcareservice provider; and the at least one processor is further configuredcompare the performance evaluation of the first healthcare serviceprovider with the performance evaluation of the second healthcareservice provider.
 18. The system of claim 17, wherein the at least oneprocessor is further configured to report the comparison to at least oneof: i) the patient, ii) the first healthcare service provider, iii) thesecond healthcare service provider, and iv) a healthcare service payor.19. A non-transitory computer-readable medium product, thenon-transitory computer-readable medium comprising instructions that,when executed by at least one processor, perform a method, the methodcomprising: receiving at least one healthcare related goal determined bya patient; receiving a healthcare record associated with the patient andpertaining to the at least one healthcare related goal from at least onehealthcare service provider; storing the healthcare record in adatabase; evaluating performance of an outcome for an activity of eachof the at least one healthcare service provider, wherein the outcome isassociated with meeting the at least one healthcare related goal; andproviding feedback to the patient regarding the performance evaluationof the at least one healthcare service provider.
 20. The non-transitorycomputer-readable medium of claim 19, wherein the medium comprises atleast one of: i) a non-volatile memory, ii) a hard disk, iii) an EPROM,and iv) a cloud-based resource.